MEDICARE: MR. GERALD WAYNE DEARING MSN, CFNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	195306-8900	UT

General Provider Information

NPI Number	:	1578883963
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GERALD WAYNE DEARING MSN, CFNP

Provider Business Mailing Address
First Line	:	2822 W 8750 S
Second Line	:
City	:	WEST JORDAN
State	:	UT
Zip	:	84088-9605
Country	:	US
Telephone Number	:	801-201-8229
Fax Number	:	801-561-7477

Provider Business Practice Location Address
First Line	:	2822 W 8750 S
Second Line	:
City	:	WEST JORDAN
State	:	UT
Zip	:	84088-9605
Country	:	US
Telephone Number	:	801-201-8229
Fax Number	:	801-561-7477

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/08/2010
Last Update Date	:	06/08/2010

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